A building body of research evidence suggests that intrauterine and early life exposures contribute to chronic disease risk in later life. While recent evidence supports the role of childhood adversities on reproductive lifespan,1-4 yet there is a limited understanding of mechanisms through which these adversities impact health. Researchers have established an association between psychosocial stressors in childhood and disruption of pubertal timing. The strongest literature is among girls, and using age at menarche (AAM) as a proxy measure for pubertal timing. Earlier age at menarche has been linked to all cause mortality,5 risk for breast cancer,6-8 cardiovascular disease,9 depression,10 metabolic syndrome11 and associated features, including overweight/obesity,12,13 insulin resistance,14 and polycystic ovarian syndrome,10 while later age at menarche is associated with depression,15,16 fractures,17-19 and lower bone mineral density.20-22 To date there has been limited exploration of psychosocial predictors of pubertal onset and the tempo of pubertal development among both girls and boys.

Psychosocial antecedents of age of menarche include: familial conflict,23 alterations in family structure,24 stressful home circumstances,25-27 paternal absence in childhood,28 and quality of familial relationships.29,30 3,25,31-34 A growing number of studies have demonstrated an association between child abuse and age at menarche.3,35-39 In the five studies to date sexual abuse has demonstrated a stronger and more consistent association with early menarche while physical abuse has had a weakly positive association in some studies.3,35-39 A shared limitation of these studies is the failure to account for additional childhood hardships, such as poverty, that are also associated with pubertal development.

The intent of this study is to investigate the independent and cumulative impact of multiple types of childhood adversities (including child abuse, neglect, family conflict, and socioeconomic status) on timing of puberty in this prospective birth cohort. We hypothesized that children exposed to higher cumulative adversities will be more likely to have altered timing of menarche-earlier or later age at onset. We proposed to investigate the relation between exposure to early life adversities and the tempo of pubertal development and timing of puberty. Specifically, we are interested in exploring the impact of exposure to physical abuse, sexual abuse, emotional abuse, neglect, and/or family conflict and the timing and tempo of pubertal development. We hypothesize that childhood adversities may impact pubertal development through influences on rate of change in BMI over time, lifestyles and health behaviours, including dietary habits, physical activity, and sedentary behaviours. Existing studies are limited by retrospective exposure assessment, and failure to consider multiple types of adversities.

Thus, a proposed mechanism linking exposure to child abuse and sexual maturation is through dysregulation of neuroendocrine systems that respond to environmental challenges (such as the hypothalamic-pituitary-adrenal (HPA), hypothalamic-pituitary-gonadal (HPG) axes. Child maltreatment is a significant psychosocial stressor and therefore may influence responsiveness of the HPA and HPG axes, neuroendocrine functioning, hormonal milieu and ultimately influence timing of sexual maturation. In addition, child abuse may be associated with nutritional factors, energy expenditure, level of activity, and health behaviors in early life that impact AAM. Compelling evidence from several recent studies suggest a relation between childhood adversities and body mass index (BMI) in adulthood.40,41 Child maltreatment has been linked to both excessive weight control and obesity,40-47 and disordered eating.48-53

A second area of interest is the relation between pubertal development and disordered eating patterns and body dissatisfaction. Puberty is one commonly cited risk factor for disordered eating, body dissatisfaction, and eating disorders.10,54 Past studies which have investigated the timing of puberty in relation to the development of eating disorders, and body dissatisfaction have produced mixed findings.54-58 A common limitation shared by previous studies includes the use of cross-sectional methodology, clinical samples, or small community samples. The advantage of the AVON study is that it is robust and comprehensive in the measurement of disordered eating and puberty, the longitudinal methodology, sample size, and sample population. This secondary analysis will focus on the impact of characteristics of pubertal development, particularly timing and tempo, on patterns of disordered eating, eating disorders, and degree of body dissatisfaction.

Please see the attached Excel spreadsheet which outlines the concepts, measures, source, and time points requested (as outlined in application item #8).

References

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